One type of health insurance that can be challenging on submitting a reimbursement and obtaining payment is a health maintenance organization (HMO) when a patient is seeking care from a non-HMO provider unless it’s in an emergency. A patient that has an HMO plan must seek care and services only from their primary care physician (PCP) (HMOs, PPO, & POS Plans, 2019). The patient’s PCP must authorize another physician for other care through a referral for the patient to see that specific physician. If a referral hasn’t been approved or authorized by the PCP or non-emergency care isn’t approved, the patient will be held responsible for the payment in full of any services that are rendered (HMOs, PPO, & POS Plans, 2019).
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